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Reform Update: Obamacare will boost malpractice claims, RAND study says


By Paul Demko
Posted: April 14, 2014 - 3:30 pm ET
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The healthcare reform law will reduce liability payouts by insurers for auto and workers' compensation claims by nearly $1.7 billion annually while increasing medical malpractice claims by $120 million a year, according to a new study released by the RAND Institute for Civil Justice.

The RAND researchers looked at the anticipated impact on insurance claims under the ACA in 2016, when the law is expected to be fully implemented. While the law's most obvious impact will be on health insurance policies, researchers found that it will also have minor but financially significant effects on claims paid by other common types of insurance policies.

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Other types of insurance are among the payers of healthcare “that we tend to forget about,” said David Auerbach, a health policy researcher at RAND and one of the study authors. “There was a lack of any hard information or rigorous analysis in this area.”

Workers' compensation payouts are anticipated to drop by more than $900 million in 2016, the researchers estimated. To understand why, the RAND report cites several examples. For instance, if a worker without health insurance suffers an injury over the weekend, that person may claim the injury was sustained on the job and seek workers' compensation. But if the person now has health coverage due to the Affordable Care Act, they are more likely to use their health plan to get any needed healthcare.

Auto insurance payouts are anticipated to decline by $740 million in 2016, the researchers said. That includes claims paid directly to the individuals who carry the policies and those paid to other individuals involved in the auto accidents. As with workers' compensation insurance, people will be more likely to seek care for a pre-existing condition through their health plan rather than claiming it was due to an auto accident.

Those reductions in liability claims are anticipated to be partially offset by an increase in medical malpractice claims. That's because insured people are more likely than uninsured people to seek medical treatment, and therefore are more likely to experience medical errors or adverse outcomes and seek compensation.

Auerbach cautioned that these are preliminary projections based on partial data. He expects further studies to provide greater clarity on the law's ramification for other types of insurance claims.

But he sees a positive impact on the other areas of insurance because such policies will pay for more of what they were intended for. Paying for healthcare “is not really their thing,” Auerbach said. “Health insurers are more versed in thinking about how to manage healthcare.”

N.Y.'s early choices credited for exchange success

New York state's health insurance exchange is crediting part of its success in holding down premiums and signing up lots of people to its original decision requiring insurers to offer the same plans off and on the exchange, the New York Times reports.

The result of that decision was that few health plans in the state offer out-of-network coverage in their off-exchange products. This has made it easier for them to maintain a cost-saving, narrow-network provider approach. While some consumers and specialized, high-cost providers were upset with the decision, New York officials say they haven't yet decided whether to require insurers to cover out-of-network care in 2015. In New York, more than 900,000 people have signed up for or commercial or government plans.

Washington required payment at sign-up

Washington state avoided the problem of having people sign up on its state exchange and then not pay their first premium by making payment part of the sign-up process, Kaiser Health News reports. All 146,000 of the new private plan enrollees through the exchange already have paid their premiums.

Follow Paul Demko on Twitter: @MHpdemko


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